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There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.
Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).
In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).
PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
We have used the VLA to make images of the planets which are continuously illuminated by the high power planetary radar transmitter on the 70 meter antenna at Goldstone, CA. That instrument is capable of transmitting up to 460,000 watts of continuous power near 8.5 GHz. Radar imaging experiments became possible after the installation of the 8.5 GHz receivers on all VLA antennas by NASA for the encounter of the Voyager spacecraft with Uranus. A similar radar may be configured with the Australia Telescope (array) at Narrabri and the Goldstone 70 m at S-band which may be important for experiments on Venus whose atmosphere strongly absorbs at X-band. Highly successful experiments have been carried out at the VLA on Mercury, Venus, Mars, Saturn's rings and Titan, the giant satellite of Saturn.
Improved solutions have been obtained for the orbit and equatorial cross-section of Mercury using radar ranging data spanning 22 years. These data have yielded new results on the precession of Mercury’s perihelion and better limits on a possible time variation in the gravitational constant G.
Radar observations are a powerful technique to study near-Earth asteroids (NEAs). Goldstone's 3.75 m resolution capability is invaluable when attempting to image NEAs with diameters smaller than 140 m. The small NEAs are a very diverse population in which we continue to discover unusual objects.
Standard estimates of the impact of Clostridium difficile infections (CDI) on inpatient lengths of stay (LOS) may overstate inpatient care costs attributable to CDI. In this study, we used multistate modeling (MSM) of CDI timing to reduce bias in estimates of excess LOS.
A retrospective cohort study of all hospitalizations at any of 120 acute care facilities within the US Department of Veterans Affairs (VA) between 2005 and 2012 was conducted. We estimated the excess LOS attributable to CDI using an MSM to address time-dependent bias. Bootstrapping was used to generate 95% confidence intervals (CI). These estimates were compared to unadjusted differences in mean LOS for hospitalizations with and without CDI.
During the study period, there were 3.96 million hospitalizations and 43,540 CDIs. A comparison of unadjusted means suggested an excess LOS of 14.0 days (19.4 vs 5.4 days). In contrast, the MSM estimated an attributable LOS of only 2.27 days (95% CI, 2.14–2.40). The excess LOS for mild-to-moderate CDI was 0.75 days (95% CI, 0.59–0.89), and for severe CDI, it was 4.11 days (95% CI, 3.90–4.32). Substantial variation across the Veteran Integrated Services Networks (VISN) was observed.
CDI significantly contributes to LOS, but the magnitude of its estimated impact is smaller when methods are used that account for the time-varying nature of infection. The greatest impact on LOS occurred among patients with severe CDI. Significant geographic variability was observed. MSM is a useful tool for obtaining more accurate estimates of the inpatient care costs of CDI.
Infect. Control Hosp. Epidemiol. 2015;36(9):1024–1030
We have measured the current-voltage characteristics of amorphous silicon thin film transistors (a-Si TFTs) over a wide range of temperatures (20 to 160°C) and determined the activation energy of the channel current as a function of gate bias with emphasis on the leakage current and subthreshold regimes. We propose a new method for estimating the density of localized states (DOS) from the dependence of the derivative of activation energy with respect to gate bias. This differential technique does not require knowledge of the flat-band voltage (VFB) and does not incorporate integration over gate bias. Using this Method, we have characterized the density of localized states with energies in the range 0.15–1.2 eV from the bottom of the conduction band and have found a wide peak in the DOS in the range of 0.8–0.95 eV below the conduction band. We have also observed that the DOS peak in the lower half of the bandgap increases in magnitude and shifts towards the conduction band as a result of thermal and bias stress. We also measured an overall increase in the DOS in the upper half of the energy gap and an additional peak, centered at 0.2 eV below the conduction band, which appear due to the applied stress. These results are in qualitative agreement with the defect pool Model [1,2].
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